QME FINAL EXAM 2024/2025 WITH DETAILED QUESTIONS
AND VERIFIED CORRECT ANSWERS/ ALREADY GRADED
A++
Workers' compensation benefits are the only exclusive remedy for injuries
suffered on the job when the employer is properly insured. If the employer
is illegally uninsured, the worker can file a civil action against the employer,
in addition to filing a workers' compensation claim.
A. True
B. False - ANSWER A. True
The Uninsured Employers' Benefit Trust Fund (UEBTF), a special unit
within the DWC may pay benefits to injured workers who get injured or ill
while working for an illegally uninsured employer. The UEBTF pursues
reimbursement of their expenditures from the responsible employer through
all available avenues, such as filing a lien against their property.
A. True
B. False - ANSWER A. True
A medical provider network (MPN) is a group of healthcare providers set up
by the employer's insurance company and approved by the DWC's
administrative director to treat workers injured on the job.
A. True
B. False - ANSWER A. True
The 24 visit cap on chiropractic care, physical therapy and occupational
therapy, does not apply to dates of injury before 1-1-04.
A. True
B. False - ANSWER A. True
Temporary Disability payments provided to an injured worker for a date of
injury on/after 1-19-04 are limited to 104 weeks. For certain injuries,
temporary disability shall not last for more than 240 weeks. Those injuries
include:
,Acute and chronic hepatitis B and C
Amputations
Severe burns
Human immunodeficiency virus (HIV)
High-velocity eye injuries
Chemical burns to the eyes
Pulmonary fibrosis
Chronic lung disease.
A. True
B. False - ANSWER A. True
The Labor Code (3600) specifically excludes from compensation 7 types of
injuries contained in the Physician's Guide. Those include:
Injuries caused by the employee's use of alcohol or illegal controlled
substances (if it can be shown that the injury would not have occurred
otherwise)
Intentionally self-inflicted injuries
Suicide, if willful and deliberate
Injuries resulting from altercations, in which the injured employee is the
'initial physical aggressor'
Injuries resulting from the employee's commission of a felony, for which the
employee has been convicted
Injuries resulting from off-duty recreational activities, where participation in
the activities does not constitute part of the employee's work related duties,
and where the activity is not an expressed or implicit condition of
employment
Psychiatric injuries claimed after notice of termination/layoff unless certain
conditions exist
A. True
B. False - ANSWER A. True
CC&R 9768.10 indicates that IMR doctors can be an MD, DO or DPM.
A. True
B. False - ANSWER A. True
,A 'Secondary Physician' is any physician other than the primary treating
physician who examines or provides treatment to the employee, but is not
primarily responsible for continuing management of the care of the
employee.
A. True
B. False - ANSWER A. True
A medical-legal report shall contain a declaration by the physician signing
the report, under penalty of perjury, stating, "I declare under penalty of
perjury that the information contained in this report and its attachments, if
any, is true and correct to the best of my knowledge and belief, except as
to information that I have indicated I received from others. As to that
information, I declare under penalty of perjury that the information
accurately describes the information provided to me and, except as noted
herein, that I believe it to be true."
The foregoing declaration shall be dated and signed by the reporting
physician and shall indicate the county wherein it was signed.
A. True
B. False - ANSWER A. True
A QME who has not paid their recertification fees or let their QME
certification lapse, cannot perform a re-evaluation of the patient, however,
can perform a supplemental report, where the worker is not examined.
A. True
B. False - ANSWER A. True
A QME may obtain a consultation from any physician as a reasonable and
necessary expense.
A. True
B. False - ANSWER B. False
The evaluator and the employee's treating physician(s) may consult as
necessary to produce a complete and accurate report.
A. True
B. False - ANSWER A. True
, All communications by the parties with the medical-legal evaluator shall be
in writing and sent simultaneously to the opposing party when sent to the
medical evaluator.
A. True
B. False - ANSWER A. True
Represented parties who have selected an Agreed Medical Evaluator or an
Agreed Panel QME shall, as part of their agreement, agree on what
information is to be provided to the AME or Agreed PQME.
A. True
B. False - ANSWER A. True
An evaluator shall not request or accept any compensation or thing of value
from any source that does or could create a conflict with his or her duties
as an evaluator.
A. True
B. False - ANSWER A. True
No physician reporting as an AME or QME shall accept gifts that have a
total fair market value in the aggregate of $360 or more, from any single
source that handles California workers' compensation matters, in the
course of any consecutive 12 months. The sources include, but are not
limited to, 1 or more attorneys, physicians, employers, claims
administrators, medical or health care or insurance or utilization review
business entities.
A. True
B. False - ANSWER A. True
"Primary treating physician' is the physician who is primarily responsible for
managing the care of an employee, and who has examined the employee
at least once for the purpose of rendering or prescribing treatment and has
monitored the effect of the treatment thereafter.
A. True
B. False - ANSWER A. True
AND VERIFIED CORRECT ANSWERS/ ALREADY GRADED
A++
Workers' compensation benefits are the only exclusive remedy for injuries
suffered on the job when the employer is properly insured. If the employer
is illegally uninsured, the worker can file a civil action against the employer,
in addition to filing a workers' compensation claim.
A. True
B. False - ANSWER A. True
The Uninsured Employers' Benefit Trust Fund (UEBTF), a special unit
within the DWC may pay benefits to injured workers who get injured or ill
while working for an illegally uninsured employer. The UEBTF pursues
reimbursement of their expenditures from the responsible employer through
all available avenues, such as filing a lien against their property.
A. True
B. False - ANSWER A. True
A medical provider network (MPN) is a group of healthcare providers set up
by the employer's insurance company and approved by the DWC's
administrative director to treat workers injured on the job.
A. True
B. False - ANSWER A. True
The 24 visit cap on chiropractic care, physical therapy and occupational
therapy, does not apply to dates of injury before 1-1-04.
A. True
B. False - ANSWER A. True
Temporary Disability payments provided to an injured worker for a date of
injury on/after 1-19-04 are limited to 104 weeks. For certain injuries,
temporary disability shall not last for more than 240 weeks. Those injuries
include:
,Acute and chronic hepatitis B and C
Amputations
Severe burns
Human immunodeficiency virus (HIV)
High-velocity eye injuries
Chemical burns to the eyes
Pulmonary fibrosis
Chronic lung disease.
A. True
B. False - ANSWER A. True
The Labor Code (3600) specifically excludes from compensation 7 types of
injuries contained in the Physician's Guide. Those include:
Injuries caused by the employee's use of alcohol or illegal controlled
substances (if it can be shown that the injury would not have occurred
otherwise)
Intentionally self-inflicted injuries
Suicide, if willful and deliberate
Injuries resulting from altercations, in which the injured employee is the
'initial physical aggressor'
Injuries resulting from the employee's commission of a felony, for which the
employee has been convicted
Injuries resulting from off-duty recreational activities, where participation in
the activities does not constitute part of the employee's work related duties,
and where the activity is not an expressed or implicit condition of
employment
Psychiatric injuries claimed after notice of termination/layoff unless certain
conditions exist
A. True
B. False - ANSWER A. True
CC&R 9768.10 indicates that IMR doctors can be an MD, DO or DPM.
A. True
B. False - ANSWER A. True
,A 'Secondary Physician' is any physician other than the primary treating
physician who examines or provides treatment to the employee, but is not
primarily responsible for continuing management of the care of the
employee.
A. True
B. False - ANSWER A. True
A medical-legal report shall contain a declaration by the physician signing
the report, under penalty of perjury, stating, "I declare under penalty of
perjury that the information contained in this report and its attachments, if
any, is true and correct to the best of my knowledge and belief, except as
to information that I have indicated I received from others. As to that
information, I declare under penalty of perjury that the information
accurately describes the information provided to me and, except as noted
herein, that I believe it to be true."
The foregoing declaration shall be dated and signed by the reporting
physician and shall indicate the county wherein it was signed.
A. True
B. False - ANSWER A. True
A QME who has not paid their recertification fees or let their QME
certification lapse, cannot perform a re-evaluation of the patient, however,
can perform a supplemental report, where the worker is not examined.
A. True
B. False - ANSWER A. True
A QME may obtain a consultation from any physician as a reasonable and
necessary expense.
A. True
B. False - ANSWER B. False
The evaluator and the employee's treating physician(s) may consult as
necessary to produce a complete and accurate report.
A. True
B. False - ANSWER A. True
, All communications by the parties with the medical-legal evaluator shall be
in writing and sent simultaneously to the opposing party when sent to the
medical evaluator.
A. True
B. False - ANSWER A. True
Represented parties who have selected an Agreed Medical Evaluator or an
Agreed Panel QME shall, as part of their agreement, agree on what
information is to be provided to the AME or Agreed PQME.
A. True
B. False - ANSWER A. True
An evaluator shall not request or accept any compensation or thing of value
from any source that does or could create a conflict with his or her duties
as an evaluator.
A. True
B. False - ANSWER A. True
No physician reporting as an AME or QME shall accept gifts that have a
total fair market value in the aggregate of $360 or more, from any single
source that handles California workers' compensation matters, in the
course of any consecutive 12 months. The sources include, but are not
limited to, 1 or more attorneys, physicians, employers, claims
administrators, medical or health care or insurance or utilization review
business entities.
A. True
B. False - ANSWER A. True
"Primary treating physician' is the physician who is primarily responsible for
managing the care of an employee, and who has examined the employee
at least once for the purpose of rendering or prescribing treatment and has
monitored the effect of the treatment thereafter.
A. True
B. False - ANSWER A. True
